The present invention relates generally to intestinal catheters and more particularly to an intestinal catheter, inserted via the nasogastric route, for aspirating both the small intestine and the stomach.
The gastrointestinal tract comprises, in descending order from the mouth or nose, the esophagus, the stomach, the small intestine and the large intestine. The small intestine or bowel comprises, in descending order, the duodenum, connected to the stomach through an opening called the pylorus, the jejunum, which connects with the duodenum at a location identified by an adjacent ligament called the ligament of Treitz, and the ileum which in turn connects with the large bowel or colon.
Certain patients suffer from an obstruction in the small intestine. This obstruction is caused by scar tissue on the outside of the small intestine which constricts or squeezes the bowel causing the bowel upstream of the obstruction to become massively dilated, i.e., swollen or puffed up, while the bowel downstream of the obstruction remains normal sized. The scar tissue which causes the obstruction usually occurs following abdominal surgery, but it can occur from inflammation of the bowel. When the obstruction occurs following abdominal surgery, it may occur within any time from a few days to several years after the surgery. Many patients having such an obstruction require surgery in order to alleviate the problem. In such a case, the abdomen is opened and the scar tissue is cut away, thereby relieving the obstruction and allowing passage of bowel content normally downstream.
Incident to such surgery, it is desirable to aspirate or remove the contents of the small bowel upstream of the obstruction.
This may be accomplished by utilizing a long intestinal catheter of the type described in Nelson U.S. Pat. No. 4,368,739. Such a catheter is inserted into the gastrointestinal tract via the nasogastric route, and it is moved downstream through the small bowel towards the obstruction. The contents of the small bowel are aspirated upstream through the tube into the proximal or upstream end of the tube, located outside the nose of the patient and connected to an aspirator or source of suction.
When inserting the catheter via the nasogastric route, the downstream or distal end of the catheter is inserted, in sequence, through the nose, the esophagus, the stomach, the duodenum and then into the jejunum. Manipulation of the catheter through the duodenum is facilitated by the provision of a pair of inflatable balloons on a downstream portion of the catheter, as is described in more detail in Nelson U.S. Pat. No. 4,368,739 and in an article entitled "A New Long Intestinal Tube", Nelson, et al., Surgery, Gynecology and Obstetrics, October, 1979, Volume 149, Pages 581-582.
At the conclusion of the surgery, the catheter is worked further downstream through the small bowel to the distal end of the latter, and then, with the catheter in place through the entire length of the small bowel, it acts as a guide for plicating the small bowel into place within the abdomen. In other words, the emplaced catheter allows the small bowel to be readily placed into an arrangement of orderly folds or convolutions, within the abdomen, without the occurrence of kinking in the small bowel as it is arranged in the convoluted disposition. The prevention of kinking is important. Otherwise, a new obstruction could occur wherever a kink is located. The inherent rigidity of the catheter within the small bowel prevents the bowel from kinking.
When the abdomen is closed following surgery, the proximal or upstream end of the catheter remains in a position outside the body of the patient, adjacent the nose, and the downstream end remains in the small bowel. During this post-operative period (e.g. 8-10 days), the contents of the small bowel may be aspirated through the catheter. Thereafter, the tube can be removed through the nose.
During the post-operative period, it is oftentimes also desirable to be able to aspirate the contents of the stomach. In the recent past, this has sometimes been accomplished through a tube inserted via the nasogastric route and terminating in the jejunum. That part of the tube located in the jejunum contained openings for feeding liquid into the jejunum for nourishing the patient during the post-operative period. There were also openings in that part of the tube located in the stomach for aspirating the contents of the stomach. The tube included separate channels or lumens for the aspirating openings in the stomach and for the feeding openings in the jejunum. A tube of this type is described in an article entitled "A New Tube For Simultaneous Gastric Decompression and Jejunal Alimentation", Nelson et al., Surgery, Gynecology and Obstetrics, April, 1985, Vol. 160, Pages 369-372.
It is desirable, during the post-operative period, to be able to aspirate the contents of the small intestine as well as the contents of the stomach. A problem which can arise during aspiration of the small intestine or stomach is a plugging or closure of the aspirating openings by the interior lining of the stomach or small intestine which are drawn against the aspirating openings by the aspirating suction. Continuously applied suction resulted in this plugging occurring almost immediately. Most hospital wards and operating rooms have only continuous suction. In order to prevent plugging, it was necessary periodically to interrupt the suction manually or to employ a special device which intermittently opened and closed the suction valve. Another expedient that prevented the immediate and persistent plugging described above was to provide a suction break within the tube. This was accomplished by having a separate lumen connected to the suction lumen near the distal end of the tube and open to the atmosphere near the proximal end of the tube to admit air, thus creating a sump tube. See Alley et al U.S. Pat. No. 3,314,430.